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<h1 class="p_Heading1"><span class="f_Heading1">Maternal &amp; Exposed Infant Registers</span></h1>

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<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none;border-spacing:0px;padding:0px;line-height: normal;"><tr style="vertical-align:baseline"><td style="border:none;padding:0;width:18px"><img id="TOGGLE0186A1_ICON" src="hmtoggle_arrow1.gif" width="9" height="9" alt="hmtoggle_arrow1" style="border:none" /></td><td style="border:none;padding:0"><span style="font-weight: bold;"><a class="dropdown-toggle" href="javascript:HMToggle('toggle','TOGGLE0186A1','TOGGLE0186A1_ICON')">Purpose</a></span></td></tr></table></div><div id="TOGGLE0186A1" style="text-align: left; text-indent: -18px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 28px;"><table class="toggletable" style="border:none; border-spacing:0px;">
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<p>&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none;border-spacing:0px;padding:0px;line-height: normal;"><tr style="vertical-align:baseline"><td style="border:none;padding:0;width:18px"><img id="TOGGLE0186A2_ICON" src="hmtoggle_arrow1.gif" width="9" height="9" alt="hmtoggle_arrow1" style="border:none" /></td><td style="border:none;padding:0"><span style="font-weight: bold;"><a class="dropdown-toggle" href="javascript:HMToggle('toggle','TOGGLE0186A2','TOGGLE0186A2_ICON')">When and Who Completes the Form</a></span></td></tr></table></div><div id="TOGGLE0186A2" style="text-align: left; text-indent: -18px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 28px;"><table class="toggletable" style="border:none; border-spacing:0px;">
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<p>&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none;border-spacing:0px;padding:0px;line-height: normal;"><tr style="vertical-align:baseline"><td style="border:none;padding:0;width:18px"><img id="TOGGLE0186A3_ICON" src="hmtoggle_arrow1.gif" width="9" height="9" alt="hmtoggle_arrow1" style="border:none" /></td><td style="border:none;padding:0"><span style="font-weight: bold;"><a class="dropdown-toggle" href="javascript:HMToggle('toggle','TOGGLE0186A3','TOGGLE0186A3_ICON')">Fill in a New Maternal and Exposed Infant Register Form</a></span></td></tr></table></div><div id="TOGGLE0186A3" style="text-align: left; text-indent: -18px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 28px;"><table class="toggletable" style="border:none; border-spacing:0px;">
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<td style="vertical-align:top; padding:2px;"><p>The active technical area should be ANC Maternity and Post Natal </p>
<p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">1.</span>From the Patient Home Page, click on the Create New Form link and select either Maternal and Exposed Infant I, II or III form</p><p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">2.</span>Fill in the form, making sure you fill in the required fields. Note that some of the fields will be auto populated.</p><p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">3.</span>Click Save</p><p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">4.</span>IQCare displays a message alerting you of any required fields not filled in</p><p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">5.</span>IQCare displays a message alerting you of a successful save and asks you if you wish to exit or stay on the form (for continued field data entry.) </p></td>
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<p>&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none;border-spacing:0px;padding:0px;line-height: normal;"><tr style="vertical-align:baseline"><td style="border:none;padding:0;width:18px"><img id="TOGGLE0186A4_ICON" src="hmtoggle_arrow1.gif" width="9" height="9" alt="hmtoggle_arrow1" style="border:none" /></td><td style="border:none;padding:0"><span style="font-weight: bold;"><a class="dropdown-toggle" href="javascript:HMToggle('toggle','TOGGLE0186A4','TOGGLE0186A4_ICON')">Update a Maternal and Exposed Infant Register Form</a></span></td></tr></table></div><div id="TOGGLE0186A4" style="text-align: left; text-indent: -18px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 28px;"><table class="toggletable" style="border:none; border-spacing:0px;">
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; padding:2px;"><p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">1.</span>To access a previously filled Maternal and Exposed Infant I, II or III form click on View Existing Forms and find the form you want to update and click the link</p><p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">2.</span>Update the form</p><p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">3.</span>Click Save</p></td>
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<p>&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none;border-spacing:0px;padding:0px;line-height: normal;"><tr style="vertical-align:baseline"><td style="border:none;padding:0;width:18px"><img id="TOGGLE0186A5_ICON" src="hmtoggle_arrow1.gif" width="9" height="9" alt="hmtoggle_arrow1" style="border:none" /></td><td style="border:none;padding:0"><span style="font-weight: bold;"><a class="dropdown-toggle" href="javascript:HMToggle('toggle','TOGGLE0186A5','TOGGLE0186A5_ICON')">Maternal and Exposed Infant I Example</a></span></td></tr></table></div><div id="TOGGLE0186A5" style="text-align: left; text-indent: -18px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 28px;"><table class="toggletable" style="border:none; border-spacing:0px;">
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; padding:2px;"><p>&nbsp;</p>
<p><img src="kemeiregi.png" width="930" height="1561" alt="KEMEIRegI" style="border:none" /></p>
</td>
</tr>
</table>
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<p>&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none;border-spacing:0px;padding:0px;line-height: normal;"><tr style="vertical-align:baseline"><td style="border:none;padding:0;width:18px"><img id="TOGGLE0186A6_ICON" src="hmtoggle_arrow1.gif" width="9" height="9" alt="hmtoggle_arrow1" style="border:none" /></td><td style="border:none;padding:0"><span style="font-weight: bold;"><a class="dropdown-toggle" href="javascript:HMToggle('toggle','TOGGLE0186A6','TOGGLE0186A6_ICON')">Maternal and Exposed Infant II Example</a></span></td></tr></table></div><div id="TOGGLE0186A6" style="text-align: left; text-indent: -18px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 28px;"><table class="toggletable" style="border:none; border-spacing:0px;">
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; padding:2px;"><p>&nbsp;</p>
<p><img src="kemeiregii.png" width="930" height="604" alt="KEMEIRegII" style="border:none" /></p>
</td>
</tr>
</table>
</div>
<p>&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none;border-spacing:0px;padding:0px;line-height: normal;"><tr style="vertical-align:baseline"><td style="border:none;padding:0;width:18px"><img id="TOGGLE0186A7_ICON" src="hmtoggle_arrow1.gif" width="9" height="9" alt="hmtoggle_arrow1" style="border:none" /></td><td style="border:none;padding:0"><span style="font-weight: bold;"><a class="dropdown-toggle" href="javascript:HMToggle('toggle','TOGGLE0186A7','TOGGLE0186A7_ICON')">Maternal and Exposed Infant III Example</a></span></td></tr></table></div><div id="TOGGLE0186A7" style="text-align: left; text-indent: -18px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 28px;"><table class="toggletable" style="border:none; border-spacing:0px;">
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; padding:2px;"><p><img src="kemeiregiii.png" width="930" height="424" alt="KEMEIRegIII" style="border:none" /></p>
</td>
</tr>
</table>
</div>
<p>&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none;border-spacing:0px;padding:0px;line-height: normal;"><tr style="vertical-align:baseline"><td style="border:none;padding:0;width:18px"><img id="TOGGLE0186A8_ICON" src="hmtoggle_arrow1.gif" width="9" height="9" alt="hmtoggle_arrow1" style="border:none" /></td><td style="border:none;padding:0"><span style="font-weight: bold;"><a class="dropdown-toggle" href="javascript:HMToggle('toggle','TOGGLE0186A8','TOGGLE0186A8_ICON')">Data Dictionaries</a></span></td></tr></table></div><div id="TOGGLE0186A8" style="text-align: left; text-indent: -18px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 28px;"><table class="toggletable" style="border:none; border-spacing:0px;">
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; padding:2px;"><div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none; border-spacing:0px; border-collapse:collapse;">
<tr style="text-align:left;vertical-align:top;">
<th colspan="7" style="vertical-align:top; height:27px; background-color:#0000ff; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 16pt; font-family: Calibri; font-weight: bold; color: #ffffff;">Maternal and Exposed Infant Form I</span></p>
</th>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-weight: bold;">Form/Registration</span></p>
</td>
<td style="vertical-align:top; width:206px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-weight: bold;">FieldName (no spaces)</span></p>
</td>
<td style="vertical-align:top; width:171px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-weight: bold;">Labeled (In the form)</span></p>
</td>
<td style="vertical-align:top; width:125px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-weight: bold;">Predefined field /existing</span></p>
</td>
<td style="vertical-align:top; width:106px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-weight: bold;">Options/list/units</span></p>
</td>
<td style="vertical-align:top; width:137px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-weight: bold;">Nature of the field</span></p>
</td>
<td style="vertical-align:top; width:92px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-weight: bold;">Required Field (Yes/No)</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal Section</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">MothersName</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Mother's Name</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Yes</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Text Single Line</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Yes</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal Section</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">LMP</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">LMP</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Yes</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal Section</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">EDD</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">EDD</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Yes</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">NoPriorARVExposure</span></p>
</td>
<td style="vertical-align:top; width:171px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No Prior ARV Exposure</span></p>
</td>
<td style="vertical-align:top; width:125px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Checkbox</span></p>
</td>
<td style="vertical-align:top; width:92px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">CurrentART</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Current ARV</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Regimen</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">CurrentARTDate</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Current ART Date</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">SingleDoseNVP</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Single Dose NVP</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Checkbox</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">SingleDoseNVPDate</span></p>
</td>
<td style="vertical-align:top; width:171px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Single Dose NVP Date</span></p>
</td>
<td style="vertical-align:top; width:125px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date</span></p>
</td>
<td style="vertical-align:top; width:92px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">PreviousRegimen</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Previous Regimen</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Regimen</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">PreviousRegimenMonthsOnRx</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Months On Rx</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Text Single Line</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">LowestCD4</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Lowest CD4</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">DecimalTextBox</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">LowestCD4Date</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Lowest CD4 Date</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">MostRecentCD4</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">MostRecentCD4</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">DecimalTextBox</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:206px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">MostRecentCD4Date</span></p>
</td>
<td style="vertical-align:top; width:171px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Most Recent CD4 Date</span></p>
</td>
<td style="vertical-align:top; width:125px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date</span></p>
</td>
<td style="vertical-align:top; width:92px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">CurrentCD4</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Current CD4</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">DecimalTextBox</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">CurrentCD4Date</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Current CD4 Date</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">HighestViralLoad</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Highest Viral Load</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">DecimalTextBox</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">HighestViralLoadDate</span></p>
</td>
<td style="vertical-align:top; width:171px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Highest Viral Load Date</span></p>
</td>
<td style="vertical-align:top; width:125px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date</span></p>
</td>
<td style="vertical-align:top; width:92px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">CurrentViralLoad</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Current Viral Load</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">DecimalTextBox</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">CurrentViralLoadDate</span></p>
</td>
<td style="vertical-align:top; width:171px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Current Viral Load Date</span></p>
</td>
<td style="vertical-align:top; width:125px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date</span></p>
</td>
<td style="vertical-align:top; width:92px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Interpartum And Infant Feeding</span></p>
</td>
<td style="vertical-align:top; width:206px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">ARVsPrescribedAntenatallyforIntrapartum</span></p>
</td>
<td style="vertical-align:top; width:171px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">ARVsPrescribedAntenatallyforIntrapartum</span></p>
</td>
<td style="vertical-align:top; width:125px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">AZT, 3TC, AZT/3TC, NVP</span></p>
</td>
<td style="vertical-align:top; width:137px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Select List</span></p>
</td>
<td style="vertical-align:top; width:92px; height:58px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Interpartum And Infant Feeding</span></p>
</td>
<td style="vertical-align:top; width:206px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Antenatal Planned option for infant feeding</span></p>
</td>
<td style="vertical-align:top; width:171px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Antenatal Plan For Prophylaxis During Breast Feeding</span></p>
</td>
<td style="vertical-align:top; width:125px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Exclusive Breast Feeding, Exclusive Replacement Feeding</span></p>
</td>
<td style="vertical-align:top; width:137px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Select List</span></p>
</td>
<td style="vertical-align:top; width:92px; height:77px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:136px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Interpartum And Infant Feeding</span></p>
</td>
<td style="vertical-align:top; width:206px; height:136px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">FeedingOption</span></p>
</td>
<td style="vertical-align:top; width:171px; height:136px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Antenatal Planned Option For Infant Feeding</span></p>
</td>
<td style="vertical-align:top; width:125px; height:136px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:136px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Exclusive Breast Feeding-(EBF), Replacement feeding - (EBMS), Mixed feeding (MF), Other, Exclusive Substitute Feeding</span></p>
</td>
<td style="vertical-align:top; width:137px; height:136px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Select List</span></p>
</td>
<td style="vertical-align:top; width:92px; height:136px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Labour, Delivery AND Postpartum History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">DeliveryAbortionMiscarriageDate</span></p>
</td>
<td style="vertical-align:top; width:171px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date Of Delivery Abortion/Miscarriage</span></p>
</td>
<td style="vertical-align:top; width:125px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date</span></p>
</td>
<td style="vertical-align:top; width:92px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Labour, Delivery AND Postpartum History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">BirthWeight</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Birth Weight (Kgs)</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">DecimalTextBox</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Labour, Delivery AND Postpartum History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">ModeofDelivery</span></p>
</td>
<td style="vertical-align:top; width:171px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Mode of Delivery</span></p>
</td>
<td style="vertical-align:top; width:125px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Normal Delivery, Caeserian Section, Breech, Assisted Vaginal, Separated</span></p>
</td>
<td style="vertical-align:top; width:137px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Select List</span></p>
</td>
<td style="vertical-align:top; width:92px; height:77px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Labour, Delivery AND Postpartum History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">InfantStatus</span></p>
</td>
<td style="vertical-align:top; width:171px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Infant Status</span></p>
</td>
<td style="vertical-align:top; width:125px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Live Birth, Still Birth, Neonatal Death</span></p>
</td>
<td style="vertical-align:top; width:137px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Select List</span></p>
</td>
<td style="vertical-align:top; width:92px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Labour, Delivery AND Postpartum History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">PlaceofDelivery</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Place of Delivery</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Home, Hospital</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Select List</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Labour, Delivery AND Postpartum History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">MaternalIntraPartumARV</span></p>
</td>
<td style="vertical-align:top; width:171px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal Intra-Partum ARV</span></p>
</td>
<td style="vertical-align:top; width:125px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">None, AZT/3TC/SdNVP, SD NVP only, HAART</span></p>
</td>
<td style="vertical-align:top; width:137px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Select List</span></p>
</td>
<td style="vertical-align:top; width:92px; height:58px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Labour, Delivery AND Postpartum History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">AFASSScore</span></p>
</td>
<td style="vertical-align:top; width:171px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Postnatal Individual Infant Feeding Counseling (AFASS score)</span></p>
</td>
<td style="vertical-align:top; width:125px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:77px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Numeric</span></p>
</td>
<td style="vertical-align:top; width:92px; height:77px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Labour, Delivery AND Postpartum History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">AFASSScoreDate</span></p>
</td>
<td style="vertical-align:top; width:171px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">AFASS Score Date</span></p>
</td>
<td style="vertical-align:top; width:125px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date</span></p>
</td>
<td style="vertical-align:top; width:92px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Labour, Delivery AND Postpartum History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">ARVsPrescribedforUsePostpartum</span></p>
</td>
<td style="vertical-align:top; width:171px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">ARVs Prescribed for Use Postpartum</span></p>
</td>
<td style="vertical-align:top; width:125px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">None, AZT/3TC/SdNVP, SD NVP only, HAART</span></p>
</td>
<td style="vertical-align:top; width:137px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Select List</span></p>
</td>
<td style="vertical-align:top; width:92px; height:58px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:97px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Labour, Delivery AND Postpartum History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:97px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">PostnatalPlannedOptionalInfant prophylaxis</span></p>
</td>
<td style="vertical-align:top; width:171px; height:97px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Postnatal Planned Optional Infant Prophylaxis</span></p>
</td>
<td style="vertical-align:top; width:125px; height:97px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:97px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">None, Continuous Maternal ART, Maternal ART until cessation of BF, Daily infant NVP</span></p>
</td>
<td style="vertical-align:top; width:137px; height:97px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Select List</span></p>
</td>
<td style="vertical-align:top; width:92px; height:97px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Labour, Delivery AND Postpartum History</span></p>
</td>
<td style="vertical-align:top; width:206px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">PostnatalFeedingOptions</span></p>
</td>
<td style="vertical-align:top; width:171px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Postnatal Feeding Options</span></p>
</td>
<td style="vertical-align:top; width:125px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Exclusive Breast Feeding, Exclusive Replacement Feeding</span></p>
</td>
<td style="vertical-align:top; width:137px; height:77px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Select List</span></p>
</td>
<td style="vertical-align:top; width:92px; height:77px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Referrals And Maternal Outcomes</span></p>
</td>
<td style="vertical-align:top; width:206px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">MaternalHIVCareReferral</span></p>
</td>
<td style="vertical-align:top; width:171px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV Care Referral</span></p>
</td>
<td style="vertical-align:top; width:125px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Referred, Attendance Confirmed</span></p>
</td>
<td style="vertical-align:top; width:137px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Select List</span></p>
</td>
<td style="vertical-align:top; width:92px; height:58px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Referrals And Maternal Outcomes</span></p>
</td>
<td style="vertical-align:top; width:206px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">MaternalHIVCareReferralDate</span></p>
</td>
<td style="vertical-align:top; width:171px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal HIV Care Referral Date</span></p>
</td>
<td style="vertical-align:top; width:125px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date</span></p>
</td>
<td style="vertical-align:top; width:92px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Referrals And Maternal Outcomes</span></p>
</td>
<td style="vertical-align:top; width:206px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">FPandRHServicesReferral</span></p>
</td>
<td style="vertical-align:top; width:171px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">FP and RH Services Referral</span></p>
</td>
<td style="vertical-align:top; width:125px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Referred, Attendance Confirmed</span></p>
</td>
<td style="vertical-align:top; width:137px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Select List</span></p>
</td>
<td style="vertical-align:top; width:92px; height:58px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:172px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Referrals And Maternal Outcomes</span></p>
</td>
<td style="vertical-align:top; width:206px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">FPandRHServicesReferralDate</span></p>
</td>
<td style="vertical-align:top; width:171px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">FP and RH Services Referral Date</span></p>
</td>
<td style="vertical-align:top; width:125px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:106px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:137px; height:39px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date</span></p>
</td>
<td style="vertical-align:top; width:92px; height:39px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
</table>
</div>
<p>&nbsp;</p>
<p>&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none; border-spacing:0px; border-collapse:collapse;">
<tr style="text-align:left;vertical-align:top;">
<th colspan="6" style="vertical-align:top; height:27px; background-color:#0000ff; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 16pt; font-family: Calibri; font-weight: bold; color: #ffffff;">Maternal and Exposed Infant Form II</span></p>
</th>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:181px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Form/Registration</span></p>
</td>
<td style="vertical-align:top; width:232px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Field Name (no spaces)</span></p>
</td>
<td style="vertical-align:top; width:217px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Labeled (In the form)</span></p>
</td>
<td style="vertical-align:top; width:129px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Predefined field /existing</span></p>
</td>
<td style="vertical-align:top; width:120px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Options/list/units</span></p>
</td>
<td style="vertical-align:top; width:138px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Nature of the field</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:181px; height:19px; padding:0px; border:solid 1px #000000;"><p>Section Name: </p>
</td>
<td style="vertical-align:top; width:232px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:217px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:129px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:120px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:138px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:181px; height:19px; padding:0px; border:solid 1px #000000;"><p>Maternal ANC Visits</p>
</td>
<td style="vertical-align:top; width:232px; height:19px; padding:0px; border:solid 1px #000000;"><p>VisitNo</p>
</td>
<td style="vertical-align:top; width:217px; height:19px; padding:0px; border:solid 1px #000000;"><p>Visit Number</p>
</td>
<td style="vertical-align:top; width:129px; height:19px; padding:0px; border:solid 1px #000000;"><p>No</p>
</td>
<td style="vertical-align:top; width:120px; height:19px; padding:0px; border:solid 1px #000000;"><p>1, 2, 3, 4, 5, 6, 7, 8</p>
</td>
<td style="vertical-align:top; width:138px; height:19px; padding:0px; border:solid 1px #000000;"><p>Select List</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:181px; height:19px; padding:0px; border:solid 1px #000000;"><p>Maternal ANC Visits</p>
</td>
<td style="vertical-align:top; width:232px; height:19px; padding:0px; border:solid 1px #000000;"><p>VisitDate</p>
</td>
<td style="vertical-align:top; width:217px; height:19px; padding:0px; border:solid 1px #000000;"><p>Visit Date</p>
</td>
<td style="vertical-align:top; width:129px; height:19px; padding:0px; border:solid 1px #000000;"><p>No</p>
</td>
<td style="vertical-align:top; width:120px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:138px; height:19px; padding:0px; border:solid 1px #000000;"><p>Date</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:181px; height:19px; padding:0px; border:solid 1px #000000;"><p>Maternal ANC Visits</p>
</td>
<td style="vertical-align:top; width:232px; height:19px; padding:0px; border:solid 1px #000000;"><p>Weight</p>
</td>
<td style="vertical-align:top; width:217px; height:19px; padding:0px; border:solid 1px #000000;"><p>Weight (Kgs)</p>
</td>
<td style="vertical-align:top; width:129px; height:19px; padding:0px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:120px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:138px; height:19px; padding:0px; border:solid 1px #000000;"><p>DecimalTextBox</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:181px; height:19px; padding:0px; border:solid 1px #000000;"><p>Maternal ANC Visits</p>
</td>
<td style="vertical-align:top; width:232px; height:19px; padding:0px; border:solid 1px #000000;"><p>SystolicBP</p>
</td>
<td style="vertical-align:top; width:217px; height:19px; padding:0px; border:solid 1px #000000;"><p>Systolic BP (mmHg)</p>
</td>
<td style="vertical-align:top; width:129px; height:19px; padding:0px; border:solid 1px #000000;"><p>No</p>
</td>
<td style="vertical-align:top; width:120px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:138px; height:19px; padding:0px; border:solid 1px #000000;"><p>Numeric</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:181px; height:19px; padding:0px; border:solid 1px #000000;"><p>Maternal ANC Visits</p>
</td>
<td style="vertical-align:top; width:232px; height:19px; padding:0px; border:solid 1px #000000;"><p>DiastolicBP</p>
</td>
<td style="vertical-align:top; width:217px; height:19px; padding:0px; border:solid 1px #000000;"><p>Diastolic BP (mmHg)</p>
</td>
<td style="vertical-align:top; width:129px; height:19px; padding:0px; border:solid 1px #000000;"><p>No</p>
</td>
<td style="vertical-align:top; width:120px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:138px; height:19px; padding:0px; border:solid 1px #000000;"><p>Numeric</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:181px; height:19px; padding:0px; border:solid 1px #000000;"><p>Maternal ANC Visits</p>
</td>
<td style="vertical-align:top; width:232px; height:19px; padding:0px; border:solid 1px #000000;"><p>Gestation(wks)</p>
</td>
<td style="vertical-align:top; width:217px; height:19px; padding:0px; border:solid 1px #000000;"><p>Gestation (wks)</p>
</td>
<td style="vertical-align:top; width:129px; height:19px; padding:0px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:120px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:138px; height:19px; padding:0px; border:solid 1px #000000;"><p>DecimalTextBox</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:181px; height:19px; padding:0px; border:solid 1px #000000;"><p>Maternal ANC Visits</p>
</td>
<td style="vertical-align:top; width:232px; height:19px; padding:0px; border:solid 1px #000000;"><p>AZT</p>
</td>
<td style="vertical-align:top; width:217px; height:19px; padding:0px; border:solid 1px #000000;"><p>AZT</p>
</td>
<td style="vertical-align:top; width:129px; height:19px; padding:0px; border:solid 1px #000000;"><p>No</p>
</td>
<td style="vertical-align:top; width:120px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:138px; height:19px; padding:0px; border:solid 1px #000000;"><p>Yes/No</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:181px; height:19px; padding:0px; border:solid 1px #000000;"><p>Maternal ANC Visits</p>
</td>
<td style="vertical-align:top; width:232px; height:19px; padding:0px; border:solid 1px #000000;"><p>HAART2</p>
</td>
<td style="vertical-align:top; width:217px; height:19px; padding:0px; border:solid 1px #000000;"><p>HAART</p>
</td>
<td style="vertical-align:top; width:129px; height:19px; padding:0px; border:solid 1px #000000;"><p>No</p>
</td>
<td style="vertical-align:top; width:120px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:138px; height:19px; padding:0px; border:solid 1px #000000;"><p>Yes/No</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:181px; height:19px; padding:0px; border:solid 1px #000000;"><p>Maternal ANC Visits</p>
</td>
<td style="vertical-align:top; width:232px; height:19px; padding:0px; border:solid 1px #000000;"><p>AdherenceCounselling</p>
</td>
<td style="vertical-align:top; width:217px; height:19px; padding:0px; border:solid 1px #000000;"><p>Adherence Counselling</p>
</td>
<td style="vertical-align:top; width:129px; height:19px; padding:0px; border:solid 1px #000000;"><p>No</p>
</td>
<td style="vertical-align:top; width:120px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:138px; height:19px; padding:0px; border:solid 1px #000000;"><p>Yes/No</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:181px; height:19px; padding:0px; border:solid 1px #000000;"><p>Maternal ANC Visits</p>
</td>
<td style="vertical-align:top; width:232px; height:19px; padding:0px; border:solid 1px #000000;"><p>Cotrimoxazole</p>
</td>
<td style="vertical-align:top; width:217px; height:19px; padding:0px; border:solid 1px #000000;"><p>Cotrimoxazole</p>
</td>
<td style="vertical-align:top; width:129px; height:19px; padding:0px; border:solid 1px #000000;"><p>No</p>
</td>
<td style="vertical-align:top; width:120px; height:19px; padding:0px; border:solid 1px #000000;"><p>Yes, No</p>
</td>
<td style="vertical-align:top; width:138px; height:19px; padding:0px; border:solid 1px #000000;"><p>Select List</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:181px; height:18px; padding:0px; border:solid 1px #000000;"><p>Maternal ANC Visits</p>
</td>
<td style="vertical-align:top; width:232px; height:18px; padding:0px; border:solid 1px #000000;"><p>NextAppointmentDate</p>
</td>
<td style="vertical-align:top; width:217px; height:18px; padding:0px; border:solid 1px #000000;"><p>Next Appointment</p>
</td>
<td style="vertical-align:top; width:129px; height:18px; padding:0px; border:solid 1px #000000;"><p>No</p>
</td>
<td style="vertical-align:top; width:120px; height:18px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:138px; height:18px; padding:0px; border:solid 1px #000000;"><p>Date</p>
</td>
</tr>
</table>
</div>
<p>&nbsp;</p>
<p>&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none; border-spacing:0px; border-collapse:collapse;">
<tr style="text-align:left;vertical-align:top;">
<th colspan="6" style="vertical-align:top; height:27px; background-color:#0000ff; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 16pt; font-family: Calibri; font-weight: bold; color: #ffffff;">Maternal and Exposed Infant Form II</span></p>
</th>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:259px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-weight: bold;">Form/Registration</span></p>
</td>
<td style="vertical-align:top; width:159px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-weight: bold;">FieldName (no spaces)</span></p>
</td>
<td style="vertical-align:top; width:179px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-weight: bold;">Labelled (In the form)</span></p>
</td>
<td style="vertical-align:top; width:123px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-weight: bold;">Predefined field /existing</span></p>
</td>
<td style="vertical-align:top; width:204px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-weight: bold;">Options/list/units</span></p>
</td>
<td style="vertical-align:top; width:89px; height:39px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-weight: bold;">Nature of the field</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:259px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri; font-weight: bold;">Section Name: </span></p>
</td>
<td style="vertical-align:top; width:159px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:179px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:123px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:204px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:89px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:259px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:159px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">MothersName</span></p>
</td>
<td style="vertical-align:top; width:179px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Mother's Name</span></p>
</td>
<td style="vertical-align:top; width:123px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Yes</span></p>
</td>
<td style="vertical-align:top; width:204px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:89px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Text Single Line</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:259px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal ART History For 24 Months After Delivery</span></p>
</td>
<td style="vertical-align:top; width:159px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">MaternalARTHistoryMonth</span></p>
</td>
<td style="vertical-align:top; width:179px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Month</span></p>
</td>
<td style="vertical-align:top; width:123px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:204px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24</span></p>
</td>
<td style="vertical-align:top; width:89px; height:58px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Select List</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:259px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal ART History For 24 Months After Delivery</span></p>
</td>
<td style="vertical-align:top; width:159px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">MaternalARTHistoryDate</span></p>
</td>
<td style="vertical-align:top; width:179px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date</span></p>
</td>
<td style="vertical-align:top; width:123px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:204px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:89px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Date</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:259px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal ART History For 24 Months After Delivery</span></p>
</td>
<td style="vertical-align:top; width:159px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">StartART</span></p>
</td>
<td style="vertical-align:top; width:179px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Start ART</span></p>
</td>
<td style="vertical-align:top; width:123px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:204px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:89px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Yes/No</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:259px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Maternal ART History For 24 Months After Delivery</span></p>
</td>
<td style="vertical-align:top; width:159px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">CurrentRegimen</span></p>
</td>
<td style="vertical-align:top; width:179px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Current Regimen</span></p>
</td>
<td style="vertical-align:top; width:123px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">No</span></p>
</td>
<td style="vertical-align:top; width:204px; height:19px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:89px; height:19px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 11pt; font-family: Calibri;">Regimen</span></p>
</td>
</tr>
</table>
</div>
</td>
</tr>
</table>
</div>
<p>&nbsp;</p>

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